Exam

Hip Exam

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Hip Exam, Hip Joint Examination, Groin Exam

  • Anatomy
  1. See Hip Anatomy
  2. Images
    1. orthoLegHipJointRtCapsuleGrayBB343.gifLewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy)
  • Precautions
  • Findings most suggestive of hip intra-articular cause
  1. Pain on external and internal hip rotation
  2. Pain on hip axial loading (force applied at foot or knee towards hip)
  • Exam
  • External to hip
  1. Critical to evaluate for referred pain
    1. Low Back Exam (e.g. radicular pain)
    2. Lower extremity Neurologic Exam (sensory and motor function)
    3. Evaluate femoral and pedal pulses
    4. Exam of Abdomen and Pelvis
      1. Appendicitis or Diverticulitis may present with Hip Pain
  2. Other common causes of pain referred to the hip
    1. Knee Exam
    2. Greater trochanter tenderness to palpation
      1. Trochanteric Bursitis
  • Exam
  • Groin
  1. Observe for groin Ecchymosis (avulsion, muscle tear, abdominal wall hematoma)
  2. Observe for bulge in the abdominal and inguinal region (Hernia)
    1. Also palpate the Superficial Inguinal Ring with valsalva or cough
  3. Examine in frog-leg position
    1. Palpate the lower Abdomen and pupic symphysis
    2. Palpate adductor insertions (pubic tubercle, medial inferior pubic ramus)
    3. Palpate abdominal muscles
    4. Palpate anterior superior iliac spine (ASIS, sartorius and tensor fasciae latae insertion)
    5. Palpate anterior inferior iliac spine (AIIS, rectus femoris insertion)
    6. Palpate anterior hip
  • Exam
  • Observation
  1. Resting position of the hip
  2. Hip deformity or swelling
  3. Overlying skin changes
  4. Hip Asymmetry
    1. Leg Length Discrepancy
    2. SI Joint Dysfunction
  1. See Hip Range of Motion for normal findings
  2. Perform active range of motion and passive range of motion
  3. Pain on even slight range of motion should suggest intrinsic hip pathology
    1. Septic Arthritis of the hip should be on the differential
    2. See causes of inability to bear weight below
  • Exam
  • Mobility and gait
  1. See Abnormal Gait
  2. Observe sitting, standing and Transferring
  3. Observe while standing
    1. Look for C Sign (Cupping the painful, anterolateral hip)
      1. OrthoHipCSign.jpg
    2. Modified Trandelenburg Test (Single leg stance phase)
      1. GaitLeftLegUpTrand.jpg
  4. Observe for limp or altered gait
    1. See Gait
    2. Trandelenburg Gait (hip adductor weakness)
    3. Waddling Gait
    4. Antalgic Gait
    5. Pelvic Rotational Wink
  5. Observe for inability to bear weight
    1. Hip Stress Fracture
    2. Hip Septic Arthritis
    3. Avascular Necrosis of the Hip
    4. Femoral lesion (e.g. malignancy)
  6. Observe for inability to climb onto exam table
    1. Decreased Hip Joint flexibility
    2. Iliopsoas muscle or quadriceps Muscle Weakness